Background: Previous studies have shown that breathing techniques reduce short acting beta(2) agonist use and improve quality of life (QoL) in asthma. The primary aim of this double blind study was to compare the effects of breathing exercises focusing on shallow nasal breathing with those of non-specific upper body exercises on asthma symptoms, QoL, other measures of disease control, and inhaled corticosteroid (ICS) dose. This study also assessed the effect of peak flow monitoring on outcomes in patients using breathing techniques. Methods: After a 2 week run in period, 57 subjects were randomised to one of two breathing techniques learned from instructional videos. During the following 30 weeks subjects practised their exercises twice daily and as needed for relief of symptoms. After week 16, two successive ICS downtitration steps were attempted. The primary outcome variables were QoL score and daily symptom score at week 12. Results: Overall there were no clinically important differences between the groups in primary or secondary outcomes at weeks 12 or 28. The QoL score remained unchanged (0.7 at baseline v 0.5 at week 28, p = 0.11 both groups combined), as did lung function and airway responsiveness. However, across both groups, reliever use decreased by 86% (p 0.10 between groups). Peak flow monitoring did not have a detrimental effect on asthma outcomes. Conclusion: Breathing techniques may be useful in the management of patients with mild asthma symptoms who use a reliever frequently, but there is no evidence to favour shallow nasal breathing over non-specific upper body exercises.
Emotion is normally regulated in the human brain by a complex circuit consisting of the orbital frontal cortex, amygdala, anterior cingulate cortex, and several other interconnected regions. There are both genetic and environmental contributions to the structure and function of this circuitry. We posit that impulsive aggression and violence arise as a consequence of faulty emotion regulation. Indeed, the prefrontal cortex receives a major serotonergic projection, which is dysfunctional in individuals who show impulsive violence. Individuals vulnerable to faulty regulation of negative emotion are at risk for violence and aggression. Research on the neural circuitry of emotion regulation suggests new avenues of intervention for such at-risk populations.
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Dysuria and bladder pain are two symptoms that commonly call attention to the lower urinary tract.
The promotion of social emotional competence (SEC) and implementation of social emotional learning (SEL) programs have increased substantially in schools, however little is known about teachers' perceptions of such programs. This qualitative study explored early childhood (three- to eight-year-old) teachers' perceptions of classroom-based social-emotional programs for young, urban-dwelling children. A focus of the study included learning what teachers believe were the critical components and challenges of such programs. Five themes emerged from the content analysis: Responsibility, Curricula/Program Design, Contextual Relevance, Support, and Barriers. The findings from this study are discussed in regards to educational policy implications about SEL curricula and programs, especially those implemented in urban schools.
Cognitive deficits have been reported in children who experienced early neglect, especially children raised in institutionalized settings. Previous research suggests that early neglect may differentially affect the directional organization of white matter in the prefrontal cortex (PFC). This may be one mechanism to explain cognitive deficits associated with neglect. To test this idea, properties of white matter and neurocognitive performance were assessed in children who suffered early neglect and those raised in typical environments (n = 63, Mage = 11.75 years). As predicted, prefrontal white matter microstructure was affected, consistent with more diffuse organization, in children that suffered early neglect and this was related to neurocognitive deficits. Such findings underscore how early adversity may affect the PFC and explain cognitive deficits associated with neglect.
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Grand Winner of the 2014 Nautilus Book AwardsThoughtful observers agree that the planetary crisis we now face-climate change; species extinction; the destruction of entire ecosystems; the urgent need for a more just economic-political order-is pushing human civilization to a radical turning point: change or perish. But precisely how to change remains an open question.In Earth-honoring Faith, Larry Rasmussen answers that question with a dramatically new way of thinking about human society, ethics, and the ongoing health of our planet. Rejecting the modern assumption that morality applies to human society alone, Rasmussen insists that we must derive a spiritual and ecological ethic that accounts for the well-being of all creation, as well as the primal elements upon which it depends: earth, air, fire, water, and sunlight. He argues that good science, necessary as it is, will not be enough to inspire fundamental change. We must draw on religious resources as well to make the difficult transition from an industrial-technological age obsessed with consumption to an ecological age that restores wise stewardship of all life. Earth-honoring Faith advocates an alliance of spirituality and ecology, in which the material requirements for planetary life are reconciled with deep traditions of spirituality across religions, traditions that include mysticism, sacramentalism, prophetic practices, asceticism, and the cultivation of wisdom. It is these shared spiritual practices that can produce a chorus of world faiths to counter the consumerism, utilitarianism, alienation, oppression, and folly that have pushed us to the brink.Written with passionate commitment and deep insight, Earth-honoring Faith reminds us that we must live in the present with the knowledge that the eyes of future generations will look back at us.
OBJECTIVES: Emerging research is revealing that direct physical contact of the human body with the surface of the earth (grounding or earthing) has intriguing effects on human physiology and health, including beneficial effects on various cardiovascular risk factors. This study examined effects of 2 hours of grounding on the electrical charge (zeta potential) on red blood cells (RBCs) and the effects on the extent of RBC clumping.DESIGN/INTERVENTIONS: SUBJECTS were grounded with conductive patches on the soles of their feet and palms of their hands. Wires connected the patches to a stainless-steel rod inserted in the earth outdoors. Small fingertip pinprick blood samples were placed on microscope slides and an electric field was applied to them. Electrophoretic mobility of the RBCs was determined by measuring terminal velocities of the cells in video recordings taken through a microscope. RBC aggregation was measured by counting the numbers of clustered cells in each sample.
SETTINGS/LOCATION: Each subject sat in a comfortable reclining chair in a soundproof experiment room with the lights dimmed or off.
SUBJECTS: Ten (10) healthy adult subjects were recruited by word-of-mouth.
RESULTS: Earthing or grounding increased zeta potentials in all samples by an average of 2.70 and significantly reduced RBC aggregation.
CONCLUSIONS: Grounding increases the surface charge on RBCs and thereby reduces blood viscosity and clumping. GrSounding appears to be one of the simplest and yet most profound interventions for helping reduce cardiovascular risk and cardiovascular events.
Environmental medicine generally addresses environmental factors with a negative impact on human health. However, emerging scientific research has revealed a surprisingly positive and overlooked environmental factor on health: direct physical contact with the vast supply of electrons on the surface of the Earth. Modern lifestyle separates humans from such contact. The research suggests that this disconnect may be a major contributor to physiological dysfunction and unwellness. Reconnection with the Earth's electrons has been found to promote intriguing physiological changes and subjective reports of well-being. Earthing (or grounding) refers to the discovery of benefits—including better sleep and reduced pain—from walking barefoot outside or sitting, working, or sleeping indoors connected to conductive systems that transfer the Earth's electrons from the ground into the body. This paper reviews the earthing research and the potential of earthing as a simple and easily accessed global modality of significant clinical importance.
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As mobile data capture tools for patient-reported outcomes proliferate in clinical research, a key dimension of measure performance is sensitivity to change. This study compared performance of patient-reported measures of mindfulness, depression, and anxiety symptoms using traditional paper-and-pencil forms versus real-time, ambulatory measurement of symptoms via ecological momentary assessment (EMA). Sixty-seven emotionally distressed older adults completed paper-and-pencil measures of mindfulness, depression, and anxiety along with two weeks of identical items reported during ambulatory monitoring via EMA before and after participation in a randomized trial of Mindfulness-Based Stress Reduction (MBSR) or a health education intervention. We calculated effect sizes for these measures across both measurement approaches and estimated the Number-Needed-to-Treat (NNT) in both measurement conditions. Study outcomes greatly differed depending on which measurement method was used. When EMA was used to measure clinical symptoms, older adults who participated in the MBSR intervention had significantly higher mindfulness and significantly lower depression and anxiety than participants in the health education intervention at post-treatment. However, these significant changes in symptoms were not found when outcomes were measured with paper-and-pencil measures. The NNT for mindfulness and depression measures administered through EMA were approximately 25–50% lower than NNTs derived from paper-and-pencil administration. Sensitivity to change in anxiety was similar across administration modes. In conclusion, EMA measures of depression and mindfulness substantially outperformed paper-and-pencil measures with the same items. The additional resources associated with EMA in clinical trials would seem to be offset by its greater sensitivity to detect change in key outcome variables.
Taking cues from science as well as mystical traditions, Boff finds that interrelatedness forms the key to a new paradigm. He critiques common approaches to ecology and discerns in the growing ecological awareness, and in the search for spirituality and meaning, the seeds of an alternative to a world of alienation, inequality and escalating natural destruction.
Most of Australia's largest mammals became extinct 50,000 to 45,000 years ago, shortly after humans colonized the continent. Without exceptional climate change at that time, a human cause is inferred, but a mechanism remains elusive. A 140,000-year record of dietary delta(13)C documents a permanent reduction in food sources available to the Australian emu, beginning about the time of human colonization; a change replicated at three widely separated sites and in the marsupial wombat. We speculate that human firing of landscapes rapidly converted a drought-adapted mosaic of trees, shrubs, and nutritious grasslands to the modern fire-adapted desert scrub. Animals that could adapt survived; those that could not, became extinct.
<p>According to the experimental results and practitioners' subjective experience, we report some hypotheses that may account for meditative phenomena during the practice of Zen-Buddhism. Orthodox Zen-Buddhist practitioners, aiming to prove the most original true-self, discover and uncover the inner energy or light on the way towards their goal. Perception of the inner light can be comprehended as resonance. Uncovering the inner energy optimizes physiological and mental health. In the meditation experiment, a significant correlation was observed between perception of the inner light and electroencephalographic (EEG) alpha blockage. We further examined this phenomenon by recording the EEG from subjects during a blessing that the subjects did not know being given. During the blessing period, significant alpha blocking was observed in experimental subjects who had been practicing meditation for years in preparation for being in resonance with the inner light. This report provides a new insight into the debate that meditation benefits our health.</p>
Asymmetry of waking electroencephalography (EEG) alpha power in frontal regions has been correlated with waking emotional reactivity and the emotional content of dream reports. Little is known regarding alpha asymmetry during sleep. The present study was performed to compare alpha power and alpha power asymmetry in various brain regions across states of sleep and wakefulness. Waking and sleep EEG were recorded in a group of patients undergoing polysomnographic evaluation for possible sleep disorders. Alpha EEG asymmetry in frontal and temporal regions was significantly correlated in waking versus sleep, particularly during rapid eye movement (REM) sleep. These results suggest that patterns of frontal alpha asymmetry are stable across sleep and waking and may be related to emotional reactivity during dreaming. During sleep, alpha power was highest during slow-wave sleep and lowest during REM sleep. Implications of these data for understanding the functional significance of alpha power during waking and sleeping are considered.
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Experienced Qigong meditators who regularly perform the exercises “Thinking of Nothing” and “Qigong” were studied with multichannel EEG source imaging during their meditations. The intracerebral localization of brain electric activity during the two meditation conditions was compared using sLORETA functional EEG tomography. Differences between conditions were assessed using t statistics (corrected for multiple testing) on the normalized and log-transformed current density values of the sLORETA images. In the EEG alpha-2 frequency, 125 voxels differed significantly; all were more active during “Qigong” than “Thinking of Nothing,” forming a single cluster in parietal Brodmann areas 5, 7, 31, and 40, all in the right hemisphere. In the EEG beta-1 frequency, 37 voxels differed significantly; all were more active during “Thinking of Nothing” than “Qigong,” forming a single cluster in prefrontal Brodmann areas 6, 8, and 9, all in the left hemisphere. Compared to combined initial–final no-task resting, “Qigong” showed activation in posterior areas whereas “Thinking of Nothing” showed activation in anterior areas. The stronger activity of posterior (right) parietal areas during “Qigong” and anterior (left) prefrontal areas during “Thinking of Nothing” may reflect a predominance of self-reference, attention and input-centered processing in the “Qigong” meditation, and of control-centered processing in the “Thinking of Nothing” meditation.
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Experienced Qigong meditators who regularly perform the exercises "Thinking of Nothing" and "Qigong" were studied with multichannel EEG source imaging during their meditations. The intracerebral localization of brain electric activity during the two meditation conditions was compared using sLORETA functional EEG tomography. Differences between conditions were assessed using t statistics (corrected for multiple testing) on the normalized and log-transformed current density values of the sLORETA images. In the EEG alpha-2 frequency, 125 voxels differed significantly; all were more active during "Qigong" than "Thinking of Nothing," forming a single cluster in parietal Brodmann areas 5, 7, 31, and 40, all in the right hemisphere. In the EEG beta-1 frequency, 37 voxels differed significantly; all were more active during "Thinking of Nothing" than "Qigong," forming a single cluster in prefrontal Brodmann areas 6, 8, and 9, all in the left hemisphere. Compared to combined initial-final no-task resting, "Qigong" showed activation in posterior areas whereas "Thinking of Nothing" showed activation in anterior areas. The stronger activity of posterior (right) parietal areas during "Qigong" and anterior (left) prefrontal areas during "Thinking of Nothing" may reflect a predominance of self-reference, attention and input-centered processing in the "Qigong" meditation, and of control-centered processing in the "Thinking of Nothing" meditation.
BACKGROUND: Chronic activation of the stress-response can contribute to cardiovascular disease risk, particularly in sedentary individuals. This study investigated the effect of a Bikram yoga intervention on the high frequency power component of heart rate variability (HRV) and associated cardiovascular disease (CVD) risk factors (i.e. additional domains of HRV, hemodynamic, hematologic, anthropometric and body composition outcome measures) in stressed and sedentary adults. METHODS: Eligible adults were randomized to an experimental group (n = 29) or a no treatment control group (n = 34). Experimental group participants were instructed to attend three to five supervised Bikram yoga classes per week for 16 weeks at local studios. Outcome measures were assessed at baseline (week 0) and completion (week 17). RESULTS: Sixty-three adults (37.2 +/- 10.8 years, 79% women) were included in the intention-to-treat analysis. The experimental group attended 27 +/- 18 classes. Analyses of covariance revealed no significant change in the high-frequency component of HRV (p = 0.912, partial eta (2) = 0.000) or in any secondary outcome measure between groups over time. However, regression analyses revealed that higher attendance in the experimental group was associated with significant reductions in diastolic blood pressure (p = 0.039; partial eta (2) = 0.154), body fat percentage (p = 0.001, partial eta (2) = 0.379), fat mass (p = 0.003, partial eta (2) = 0.294) and body mass index (p = 0.05, partial eta (2) = 0.139). CONCLUSIONS: A 16-week Bikram yoga program did not increase the high frequency power component of HRV or any other CVD risk factors investigated. As revealed by post hoc analyses, low adherence likely contributed to the null effects. Future studies are required to address barriers to adherence to better elucidate the dose-response effects of Bikram yoga practice as a medium to lower stress-related CVD risk. TRIAL REGISTRATION: Retrospectively registered with Australia New Zealand Clinical Trials Registry ACTRN12616000867493 . Registered 04 July 2016.
BACKGROUND: Chronic activation of the stress-response can contribute to cardiovascular disease risk, particularly in sedentary individuals. This study investigated the effect of a Bikram yoga intervention on the high frequency power component of heart rate variability (HRV) and associated cardiovascular disease (CVD) risk factors (i.e. additional domains of HRV, hemodynamic, hematologic, anthropometric and body composition outcome measures) in stressed and sedentary adults. METHODS: Eligible adults were randomized to an experimental group (n = 29) or a no treatment control group (n = 34). Experimental group participants were instructed to attend three to five supervised Bikram yoga classes per week for 16 weeks at local studios. Outcome measures were assessed at baseline (week 0) and completion (week 17). RESULTS: Sixty-three adults (37.2 +/- 10.8 years, 79% women) were included in the intention-to-treat analysis. The experimental group attended 27 +/- 18 classes. Analyses of covariance revealed no significant change in the high-frequency component of HRV (p = 0.912, partial eta (2) = 0.000) or in any secondary outcome measure between groups over time. However, regression analyses revealed that higher attendance in the experimental group was associated with significant reductions in diastolic blood pressure (p = 0.039; partial eta (2) = 0.154), body fat percentage (p = 0.001, partial eta (2) = 0.379), fat mass (p = 0.003, partial eta (2) = 0.294) and body mass index (p = 0.05, partial eta (2) = 0.139). CONCLUSIONS: A 16-week Bikram yoga program did not increase the high frequency power component of HRV or any other CVD risk factors investigated. As revealed by post hoc analyses, low adherence likely contributed to the null effects. Future studies are required to address barriers to adherence to better elucidate the dose-response effects of Bikram yoga practice as a medium to lower stress-related CVD risk. TRIAL REGISTRATION: Retrospectively registered with Australia New Zealand Clinical Trials Registry ACTRN12616000867493 . Registered 04 July 2016.
OBJECTIVES: The purpose of this study was to investigate the effect of 16 weeks of Bikram yoga on perceived stress, self-efficacy and health related quality of life (HRQoL) in sedentary, stressed adults. DESIGN: 16 week, parallel-arm, randomised controlled trial with flexible dosing. METHODS: Physically inactive, stressed adults (37.2+/-10.8 years) were randomised to Bikram yoga (three to five classes per week) or control (no treatment) group for 16 weeks. Outcome measures, collected via self-report, included perceived stress, general self-efficacy, and HRQoL. Outcomes were assessed at baseline, midpoint and completion. RESULTS: Individuals were randomised to the experimental (n=29) or control group (n=34). Average attendance in the experimental group was 27+/-18 classes. Repeated measure analyses of variance (intention-to-treat) demonstrated significantly improved perceived stress (p=0.003, partial eta(2)=0.109), general self-efficacy (p=0.034, partial eta(2)=0.056), and the general health (p=0.034, partial eta(2)=0.058) and energy/fatigue (p=0.019, partial eta(2)=0.066) domains of HRQoL in the experimental group versus the control group. Attendance was significantly associated with reductions in perceived stress, and an increase in several domains of HRQoL. CONCLUSIONS: 16 weeks of Bikram yoga significantly improved perceived stress, general self-efficacy and HRQoL in sedentary, stressed adults. Future research should consider ways to optimise adherence, and should investigate effects of Bikram yoga intervention in other populations at risk for stress-related illness. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry ACTRN12616000867493. Registered 04 July 2016. URL: http://www.anzctr.org.au/ACTRN12616000867493.aspx.
OBJECTIVES: The purpose of this study was to investigate the effect of 16 weeks of Bikram yoga on perceived stress, self-efficacy and health related quality of life (HRQoL) in sedentary, stressed adults. DESIGN: 16 week, parallel-arm, randomised controlled trial with flexible dosing. METHODS: Physically inactive, stressed adults (37.2+/-10.8 years) were randomised to Bikram yoga (three to five classes per week) or control (no treatment) group for 16 weeks. Outcome measures, collected via self-report, included perceived stress, general self-efficacy, and HRQoL. Outcomes were assessed at baseline, midpoint and completion. RESULTS: Individuals were randomised to the experimental (n=29) or control group (n=34). Average attendance in the experimental group was 27+/-18 classes. Repeated measure analyses of variance (intention-to-treat) demonstrated significantly improved perceived stress (p=0.003, partial eta(2)=0.109), general self-efficacy (p=0.034, partial eta(2)=0.056), and the general health (p=0.034, partial eta(2)=0.058) and energy/fatigue (p=0.019, partial eta(2)=0.066) domains of HRQoL in the experimental group versus the control group. Attendance was significantly associated with reductions in perceived stress, and an increase in several domains of HRQoL. CONCLUSIONS: 16 weeks of Bikram yoga significantly improved perceived stress, general self-efficacy and HRQoL in sedentary, stressed adults. Future research should consider ways to optimise adherence, and should investigate effects of Bikram yoga intervention in other populations at risk for stress-related illness. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry ACTRN12616000867493. Registered 04 July 2016. URL: http://www.anzctr.org.au/ACTRN12616000867493.aspx.
OBJECTIVE: The aim oft his study was to compare the effects of 10 common exercises to traditional pelvic floor muscle (PFM) contractions (Kegel) on levator hiatus (LH) area and PFM length and strength. METHODS: This is a cross-sectional study of 15 healthy postpartum women. Ten exercises were studied. These were common variations of leg, core, and back exercises used in yoga, Pilates, strength training, and physical therapy. Each participant performed all 10 exercises at a single visit in 2 examination settings: transperineal ultrasound and perineometry. Ultrasound measured the LH area and PFM length, and perineometry measured the muscle strength (peak squeeze pressure). RESULTS: Kegel generates an increase in squeeze pressure (24.3 cm H2O), shortens the muscles (-0.46 cm) and narrows the LH (-0.13 cm). The bird-dog and plank exercises were not different from Kegel in any measurement. While the leg-lift ultrasound dimensions are similar to Kegel, leg lifts generated peak squeeze pressures stronger than any other exercise (including Kegel). Whereas ultrasound dimensions were similar to Kegel, tucked and untucked squats and thigh adductions generated weaker contractions than Kegel. While crunch generated a squeeze pressure similar to Kegel, the ultrasound dimensions showed a significantly wider LH and longer muscle than Kegel. Bridge, clam, and plie exercises affected the PFMs differently than Kegel in all measures. CONCLUSIONS: Bird-dog, plank, and leg-lift exercises should be evaluated as alternative exercises to Kegel as they affect PFM strength and length and LH area similarly to Kegel, and leg lifts generate a stronger contraction than Kegel.
Meditation practices may impact physiological pathways that are modulated by stress and relevant to disease. While much attention has been paid to meditation practices that emphasize calming the mind, improving focused attention, or developing mindfulness, less is known about meditation practices that foster compassion. Accordingly, the current study examined the effect of compassion meditation on innate immune, neuroendocrine and behavioral responses to psychosocial stress and evaluated the degree to which engagement in meditation practice influenced stress-reactivity. Sixty-one healthy adults were randomized to 6 weeks of training in compassion meditation (n=33) or participation in a health discussion control group (n=28) followed by exposure to a standardized laboratory stressor (Trier Social Stress Test [TSST]). Physiologic and behavioral responses to the TSST were determined by repeated assessments of plasma concentrations of interleukin (IL)-6 and cortisol as well as total distress scores on the Profile of Mood States (POMS). No main effect of group assignment on TSST responses was found for IL-6, cortisol or POMS scores. However, within the meditation group, increased meditation practice was correlated with decreased TSST-induced IL-6 (rp =-0.46, p=0.008) and POMS distress scores (rp =-0.43, p=0.014). Moreover, individuals with meditation practice times above the median exhibited lower TSST-induced IL-6 and POMS distress scores compared to individuals below the median, who did not differ from controls. These data suggest that engagement in compassion meditation may reduce stress-induced immune and behavioral responses, although future studies are required to determine whether individuals who engage in compassion meditation techniques are more likely to exhibit reduced stress reactivity.
Meditation practices may impact physiological pathways that are modulated by stress and relevant to disease. While much attention has been paid to meditation practices that emphasize calming the mind, improving focused attention, or developing mindfulness, less is known about meditation practices that foster compassion. Accordingly, the current study examined the effect of compassion meditation on innate immune, neuroendocrine and behavioral responses to psychosocial stress and evaluated the degree to which engagement in meditation practice influenced stress-reactivity. Sixty-one healthy adults were randomized to 6 weeks of training in compassion meditation (n=33) or participation in a health discussion control group (n=28) followed by exposure to a standardized laboratory stressor (Trier Social Stress Test [TSST]). Physiologic and behavioral responses to the TSST were determined by repeated assessments of plasma concentrations of interleukin (IL)-6 and cortisol as well as total distress scores on the Profile of Mood States (POMS). No main effect of group assignment on TSST responses was found for IL-6, cortisol or POMS scores. However, within the meditation group, increased meditation practice was correlated with decreased TSST-induced IL-6 (rp =-0.46, p=0.008) and POMS distress scores (rp =-0.43, p=0.014). Moreover, individuals with meditation practice times above the median exhibited lower TSST-induced IL-6 and POMS distress scores compared to individuals below the median, who did not differ from controls. These data suggest that engagement in compassion meditation may reduce stress-induced immune and behavioral responses, although future studies are required to determine whether individuals who engage in compassion meditation techniques are more likely to exhibit reduced stress reactivity.
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Much evidence from pain patients and animal models shows that chronic pain does not exist in a vacuum but has varied comorbidities and far-reaching consequences. Patients with long-term pain often develop anxiety and depression and can manifest changes in cognitive functioning, particularly with working memory. Longitudinal studies in rodent models also show the development of anxiety-like behavior and cognitive changes weeks to months after an injury causing long-term pain. Brain imaging studies in pain patients and rodent models find that chronic pain is associated with anatomical and functional alterations in the brain. Nevertheless, studies in humans reveal that lifestyle choices, such as the practice of meditation or yoga, can reduce pain perception and have the opposite effect on the brain as does chronic pain. In rodent models, studies show that physical activity and a socially enriched environment reduce pain behavior and normalize brain function. Together, these studies suggest that the burden of chronic pain can be reduced by nonpharmacological interventions.
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